Older Adults' Health and Preferences for Care in Europe: A Cross-National, Multilevel Study

Sociological and gerontological perspectives conceptualize individuals' lives as embedded within multiple layers of "social context," such as meso-level social network ties and social structural disadvantage as well as macro-level national characteristics, such as culture or policy/economics. Empirical literature notes the potential positive effect of "social activity network" ties (e.g., activity-related ties and family network ties) on health, yet this relationship may vary cross-nationally. In addition, non-traditional national cultural values, a strong welfare state, and heightened individual-level need (e.g., low income or a lack of family support) are all linked to public support for a variety of state-based provisions and thus may also predict older adults' preferences for state-based (versus family-based) care. Although a few studies conceptualize nation-level and individual-level factors jointly in the lives of older adults cross-nationally, very few scholars attempt to assess cross-national variation in health or preferences for care using empirical measures of national and individual characteristics. In this project, I create a multilevel dataset using individual-level data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) and nation-level data from the World Values Survey (WVS), European Values Study (EVS), World Bank (WB), United Nations (UN), and Organisation for Economic Co-Operation and Development (OECD) in order to empirically assess cross-national variation in older adults' health and preferences for care. The results of this study reveal that a multilevel consideration of national and individual characteristics offers a unique and nuanced view into older adults' social lives, health outcomes, and preferences for care in old age. Specifically, national familistic culture and public pension expenditures contextualize the effect of social activity network ties on older adults' health. Further, national culture is associated with older adults' preferences for care in old age, while heightened individual-level need may cause individuals to turn to the types of care most commonly available in their country. Overall, the results reveal the dominant role of culture in shaping older adults' social expectations, social activity network health benefits, and care preferences in old age. In addition, although welfare state generosity does not have a direct effect on health or preferences for care, the more subtle influence of economic development frames older adults' opportunities for health promotion and support in old age. I end with a discussion of the short-term and long-term implications of these findings for older adults' social activity networks, health, and care options in light of cross-national inequality.